With Skilled Nursing Facilities on the brink of crisis since before the start of the pandemic, industry leaders and policymakers have proposed solutions to ensure sufficient staff. For example, various stakeholders around the nursing home industry suggested staffing minimums, new hiring models, and increased worker benefits but often to no avail.
Calls for better staffing resonated with the Biden Administration, which has now set its sights on a federal staffing minimum for SNFs. However, despite the measure's constructive intentions, many healthcare authorities are skeptical of these minimums.
Industry Perspectives
The American Health Care Association voiced multiple concerns about a potential staffing minimum on behalf of its 14,000 long-term care facilities. According to NPR, the organization's president, Mark Parkinson, called the proposal "unrealistic" and questioned whether the administration could enact it without Congress.
If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country.
Medplace's Barbara Pridemore, LPN, who has over 25 years of experience in Geriatrics and 12 years as a long-term care surveyor, weighed in on the state of nursing homes and potential changes.
Back in the day, when I was a very new surveyor, I thought this would be so easy if we had mandatory staffing. You walk in, here's your Census. You better have X number of RNs, LPNs and CNAs. But it's never been like that. So, when you come in and say, "We're going to demand that you have mandatory staffing ratios", that puts facilities in a hard spot because every facility is different. What your mom might need might differ from what my mom might need. Do you have to provide 4.1 hours of care to somebody that doesn't need it when you got somebody over here that's only getting 3.4 hours?
Rethinking Staffing to Protect SNFs and their Patients
Perspectives from medical professionals point toward a situation without simple fixes. Skilled nursing news highlighted examples of creative, alternative solutions in long-term care.
Pennsylvania used its 17.5% Medicaid reimbursement into 2023 as a buffer, slowly increasing the minimum ratio to 3.2 by 2024. This way, facilities have time to adjust and hire new staff. The measure coincided with increasing spending minimums, requiring that operators allocate 70% of new funds to bedside care.
A wave of SNF legislation in Pennsylvania and Georgia aimed more directly at staffing. But instead of implementing minimums and risk shutting down facilities, they added multiple new benefits to attract and retain workers. These include:
- Shift flexibility and differentials
- Retention and recruitment bonuses
- Transportation
- More frequent pay periods
- Daycare compensation
For Pridemore, solutions for SNFs mean treating staff with the same importance as their patients.
I think we have to get our priorities in order. We often say that people in nursing homes are the most vulnerable and the neediest. And if that's true, why aren't we doing more to honor and protect them as a society? I've seen incredibly dedicated people that have worked in nursing homes for over 20 years. That is love and commitment and we need to honor that. We want them to treat our loved ones as close to as what we would.
